Case report

A 54-year-old man developed acute-onset right-sided neck and ear pain, right lower motor neurone facial nerve palsy and right-side Horner’s syndrome following a fall with hyperextension of the neck. He also had right facial anhidrosis. MR scan and MR angiogram of the head and neck identified a right internal carotid artery dissection at the skull base (figure 1). He was treated conservatively with antiplatelet therapy. After 2 months, his facial palsy had almost resolved (figure 2A) but partial ptosis with miosis remained (figure 2B). Starch iodine test confirmed the absence of right facial sweating (figure 2C) but without contralateral facial flushing or ipsilateral pallor.